Stop obsessing about your posture and thinking effective pain solutions

As chiropractors, we often get queries about people wanting to fix their posture. In doing so, they hope to resolve their pain. However, there’s little to no evidence that suggest that posture improvement can be a pain solution. Here are … reasons why.

You don’t need good posture to have no pain

We will start with the hard science because … well, we are an evidence-based chiropractic clinic. Being evidence-based is about looking at hard data, and letting this information guide our decision making.

Since as early as 2016, studies have already reported that there’s no association between neck pain and a forward head posture. If there’s no association (i.e., no relationship) between the two, it would be impossible for a “text neck” to cause neck pain. What the study did find that people who exercised regularly were more likely to have good posture!

If that is not compelling enough, a different study published last year found slumped postures and forward head positioning were protective of neck pain. What that means is that, with a “bad posture”, you were LESS likely to get neck pain.

Isn’t that mind blowing?

It makes sense though. Your body is designed to move freely rather than to be kept in a fixed position. In that sense, being able to move through all positions is probably healthier than restricting it to one movement.

In a separate study, lifting with neutral spine (i.e., straight back) is associated with fear-avoidance behaviour rather than healthy spines!

With all of this in mind, there are three takeaways:

• What you consider as bad posture may not actually be bad for you.
• Improving your posture may not necessary make your pain go away.
• People with upright postures have stronger fears of bad posture, and don’t necessarily have healthier spines.

There is nothing natural about symmetries

People talk about imbalances like it’s an absolute bad thing. Like, we need to have total symmetry to be healthy. This is totally unfounded as perfect symmetry is rare, or impossible to find, in nature. For example, you probably already know that your face is not perfectly symmetrical.

Do you get facial pain as a result of this asymmetry?

I am guessing no.

If that’s the case, why are we so adamant of having perfectly symmetrical postures but yet so accepting towards having an asymmetrical face?

The reality is that being different side to side is part and parcel of our life. It is completely natural, and is nothing to be afraid of. In fact, we are fundamentally so different side to side that even our armpits smell different! The reason is because of our arm dominance. Because we use one arm differently from the other, the sweat production is also different. What this lead to is a difference in microbial activity between your left and right armpits.

You can excel with extreme imbalances

We are so so so fixated on having a balanced body that we forget to look past. There are, in fact, many athletes who excel with their their so called imbalances.

My favourite example will be Australian gymnast Clay Stevens. He was born without a pectoral muscle and also a world class gymnast!

If he was born in Singapore, he’d probably be excused from PE (Physical Education) and may be left to live a completely sedentary life. We often view deviations from what we are used to as unhealthy, and forget to consider that the body is in fact robust and adaptable.

To give yourself a good shot at recovery, you will need to first be objective about what your body is capable of doing. Instead of trying to fit our bodies into our beliefs or assumptions, it’ll be good to take a data-centric approach to consider what your body can truly do. With this approach, you will be able to truly optimise your physical health, and achieve peak performance.

Let’s put it this way, if someone can do vaults and flips at a world championship level without a pectoral muscle, you can definitely sit at your desk and particulate in all activities of daily living with your minor and completely natural asymmetries.

Your “imbalance” can be your saving grace

The posture you have is probably the result of how you have been using your body. In that sense, your body probably adopted your current posture because it is more efficient for you to be sitting or standing this way. This adaptation is a good thing!

When it comes to professional sports, certain adaptations do help athletes perform better, and perhaps reduced their risk of injury. There is lots of talk about mobility and flexibility, as if more is always better. However, this is not true.

Take for example, a ballerina. They are great on stage, and they are adapted to what they need to do. Their range of motion is mindblowing and they are able to get into positions that you and I could probably never achieve in our lifetime.

It is wonderful!

But what do you think would happen if you put these ballerinas into the rugby pitch? How do you think those shoulders and hips would respond to the stress of contact sport?

No, I am not saying rugby is superior to ballet. In fact, the risk of injuries for rugby players are just as high if you were to make them prance to Tchaikovsky.

Our perceived imbalances are not always our enemies. Instead of subscribing to an arbitrary standard what is good and balanced physique, you should consider how your current posture could perhaps be advantageous to you.

Sure, you could change your posture. However, that doesn’t mean your new posture is going to be better for you.

“Text neck” is not entirely a 21st century phenomenon

I am not sure who first coined the phrase “text neck” but a anterior head carriage is definitely not unique to the 21 century. Sure, mobile phones are, but the forward head posture is not.

If we were to look into history, we do see that having your head slump over something existed since hundreds or even thousand of years ago.

We must be willing to consider that people started working in slumped postures since before industrial revolution. If we were to look at photographs of factory workers from the period, we can see that they are slouched over assembly lines.

It should be noted that working conditions then were abhorable. Working hours are long. A 16-hour shift was not uncommon. This means people would spent hours and hours squinting at machinery under poor light conditions.

This is 200 to 300 years ago. The idea of spending prolonged hours in what is now perceived to be “text neck” is 100% not unique to our generation. In fact, people back then probably spent more time in slouched positions then we do today.

Despite the poor work conditions, chronic neck and back pain didn’t seem to as prevalent then as it is today. According to the epidemiology studies (e.g., studies of how diseases occur), back pain only became a major issue in the 1970s. In fact, it is so bad that New York Times referred to it as The Special Pain of the 20th century.

If “poor posture” is considered to be bad for our health, why did it only become a problem for us in the 1970s?

With all of these data points, it is difficult to not appreciate that posture alone doesn’t cause to neck pain. Sure, sitting in awkward positions or in confined spaces (e.g., long haul flights) can be ridiculously uncomfortable. This discomfort, however, resolves within hours once your neck is allowed to move freely.

“Poor posture” can indeed also aggravate your existing neck pain. No one is contesting that. That also doesn’t mean it causes your neck aches and soreness. While it does take some of the edge off, should you allow your neck to assume it’s preferred position, it doesn’t lead you to a true recovery.

The bottom line? Postural pain does exist where you feel a discomfort when your neck is put into awkward positions for prolonged period of time. This pain self-resolves and is not an issue for you. What you have is neck pain that could be aggravated by putting your neck into certain positions. Your symptom experience does indeed improve once you move out of it. However, changing your posture alone is not going to cure you from your neck condition.

Good posture is a social aesthetic construct

We think posture is linked to physical health but did you know posture was historically attributed to beauty and intelligence?

Wearing a corset was introduced into French court by Catherine de Medici in 1500s and it was considered “dispensable to the beauty of the female figure”. The purpose was to keep ladies in an upright posture with the shoulders down, and shoulder blades tucked back together. In those days, that was the good posture, and it is an aesthetic construct.

At the turn of the 19th century, things started to posture. An upright posture was regarded as a sign of superior intelligence. During that period, physical traits were linked to everything from homosexuality to insanity to intelligence. Because the torso contains vital organs, men and women with long trunks and short legs were highly regarded.

It was only in 1914 before posture was linked to physical health. The American Posture League (now defunct) advocated for upright posture, and that it was necessary for full health. They even organised postural programs throughout American schools. Children were often stripped to their underwear for posture and testing purposes.

While the posture and physical health narrative may seem compelling, it’s not based on science. In fact, modern science and research is not able to find a link between physical functioning, pain, and posture.

We like to think having a good posture is natural, and the way things are supposed to be. Yet from history, we can see that upright posture is something that is not intuitive and often has to be artificially developed.

Chiropractic treatment for neck pain

As neck pain chiropractors in Singapore, we have lots of questions on why we don’t offer chiropractic adjustments at our clinic. The short answer is because spinal adjustment is not a long-term solution. If cracking your spine can lead to a successful recovery, then why are chiropractic patients expected to continue with regular treatments for the rest of their life?

In our opinion, needing a lifetime of treatment is not recovery at all. For us, a full recovery is about being able to live the life you want without having to depend on anyone. It is our responsibility  as allied health providers to help you achieve that. This is why we empower our clients at Square One Active Recovery. This is why we aim to make our own services redundant to our clients.

We use exercise, education, and lifestyle change in our recovery programme to help our clients find freedom from pain. With this approach, you can attain your recovery goals without needing regular treatments. This is aligned to best evidence practice, and also congruent to what chiropractic is about since its founding days.

In that sense, we are not reinventing the wheel.

The truth is that exercise has been part of chiropractic since its infancy. We see that early chiropractors did utilise exercise as part of their treatment approach. So, what we are doing at our practice is 100% part of chiropractic.

Yes, we do realise that few chiropractors in Singapore do what we do. It makes sense. Afterall, spinal adjustments only take five minutes to perform and the relief lasts for a few days or a couple of weeks, max. This means it’s good for business!

Then turnover is high (i.e., can see many patients in a day) and the recurring revenue is high (i.e., patients have to keep coming back). No wonder chiropractors choose to focus on cracking spines!

We are not saying that you don’t feel better from having your spine adjusted. We are saying the results don’t last. We are also saying that there are better pain solutions. Research backs this up.

With the growth of science and research, we starting to learn more about body, and what actually helps with recovery. Both chiropractors and pain patients alike would have to keep up in order to achieve good outcomes. Yes, all of us have our own biases, beliefs, values. We are not denying that.

What we are saying is that, at some point, all of these have to go if we want good outcomes. We have to keep up with times. Especially if you are not getting better.

Have a think about it. You can’t keep doing the same thing and expecting a different result. What you need for extraordinary results is a radical change. This can start with the type of treatments you choose.

Exercises for neck pain

It’s almost impossible for you to achieve a full recovery from the exercises we are about to share. However, it is possible that they may bring you some pain relief.

It is true that everybody can exercise on their own, and that there are tons of exercise resource available for free online. What you need, however, is more than that. In order to achieve good treatment outcomes from exercise, you need to be able to piece them together in a meaningful way. This require professional expertise.

It’s not reasonable to expect that you will get better as long as you exercise. After all, it is possible for people who exercise regularly to experience pain. You’ll need guidance on what is the right exercise to do, when you should do it, how often, how many times, and at what intensity.

Every case is different and what you need will be different from what another person needs. This is why a personalised approach to recovery is also important.

TRX rows  aka inverted row

The first exercise we’d like to introduce is the TRX rows. If you do not have access to TRX straps, you can use a inclined pull-up bar that are commonly found at public fitness corners. Alternatively, you can also use the edge of a sturdy table to perform the inverted rows.

You may find it strange that we choose the inverted row for neck pain, because there are no neck movements involved. The reason is because your neck, shoulder, and middle back works together as a complex. Even if there is no direct neck involvement, it will still help with your recovery. This is validated by Cochrane in their 2015 exercise for neck pain guidelines.

• To start, hold the handles of your TRX facing the anchor point. Slowly lower yourself into an inclined position by extending your arms and moving your feet closer to the anchor point.
• Squeeze your shoulder blade as hard as you can and slowly row yourself up.
• Once you are ready, slowly lower yourself back to the start position.

Isometric neck lateral flexion

For those of you who are looking for something that’s more accessible that can be easily performed day to day, isometric* neck exercises would perfect for you. Isometric exercises are great because there is no movements involved. This means that there’s a good chance that this exercise is suitable for you even if your neck symptoms are aggravated by movements.

• To start, sit in a comfortable position with your neck and head in a relaxed position. Do not worry about trying to assume any “correct” position.
• Place your palm on your side of your head around your temple, and slowly push your head into your hand. Be sure to resist your head with your hand so there is no movement of the neck.
• Hold the contraction for 6 to 12 seconds, and slowly relaxed.

When performing this exercise, an exertion of 30-40% of your maximum effort is good enough. Once you are comfortable, you can slowly increase the exertion to 60-80%. It is unlikely that you will need to push beyond that. More is not always better!

The lateral flexion alone is enough for you to start seeing improvement. If you prefer, you may choose to do this isometric exercise for all your neck movements (e.g., forward flexion, extension, rotation).

*The word isometric can be broken down to iso- meaning same, and metric meaning meter or relating to distance or length. Thus, isometric exercises are performed with your joints being kept at the same distance (i.e., no movement). It can also be thought of as muscle length being at a fixed length (i.e., no true shortening of muscle).

I have tried your exercises and I am not better!

Do not be too discouraged if you don’t find the exercises helpful. This is not because exercises are useless or that you will never get better. What you need is probably extra attention for your case, and a recovery programme that is truly tailored to you.

Remember, exercise alone is not enough to give you a full recovery. Pain relief alone also doesn’t indicate complete recovery. A combination of exercise, education, and lifestyle change is what it takes for you to find true freedom from pain.

To find out more about how we can help you help yourself in your recovery, reach out to us via the contact form below. Come discover the difference the right care can make.